Ambetter from Buckeye Health Plan

Dear Revdex.com of Ohio,After review of the complaint # [redacted] filed by an Ambetter member, [redacted] ***We have researched the complaint and a letter has been sent out to the member informing her of conclusion of this review.Thank you for bringing this individual’s concerns to our attention and allowing us the opportunity to respond.Thank you.Shamain M [redacted] *

Dear Revdex.com of Ohio,After review of the complaint filed by an Ambetter member, [redacted] ***We have researched the complaint and a letter has been sent out to the member informing her of conclusion of this review.Thank you for bringing this individual's concerns to our attention and allowing us the opportunity to respondThank youNatalie LT***Grievance and Appeals Coordinator I

Dear Revdex.com of Ohio, Ambetter from Buckeye Health Plan has completed the Revdex.com of Ohio (Revdex.com) review for one of our membersPlease see the following information below regarding the outcome of our review, referenced by Revdex.com case [redacted] After review of the complaint filed by our member regarding the denial of claims for February under the Ambetter plan, it has been determined that Ambetter has denied the claims due to DrRichard *** not being a participating provider within the Ambetter networkAccording to the Ambetter plan, it is the member’s responsibility to ensure that they are utilizing participating providers prior to services being rendered We have reviewed the members records and was not able locate any phone calls pertaining to verification of Dr [redacted] participating within the Ambetter networkTherefore, the claims for Dr [redacted] due to non-network participationIf the member does not agree with our determination, our member has the right to file a claim dispute within days from the date of the denialPlease submit all claim disputes to the following address belowAmbetter form Buckeye [redacted] Thank you for the opportunity to review our member’s complaint, and to offer a responseWe hope that this outcome is favorable to our member Thank you, [redacted] Buckeye Health Plan

The response is addressed to [redacted] That is not me!! I feel that Ambetter is not clearly hearing my complaint(s) I don't know how much louder that I can emphasize "BAIT AND SWITCH." This is both disrespectful and ignorant My complaint stands, and my requests still remain unmet I encourage Ambetter to review this complaint again, and come up with an intelligent response this time Regards, [redacted] ***

Revdex.com: I reviewed the response made by the business in reference to complaint ID [redacted] , I understand that they are not the branch of the company that handles my policyHowever, I DO have "Ambetter" insurance and can literally login on their [redacted] website, so they are not some other company, I did not see one of their entities in Texas when filing this complaint, but they are the same peoplePlease forward my complaint to the Texas Revdex.com if you are able [redacted]

I am rejecting this response because when I initially researched the marketplace for affordable health care insurance plansThe process to ensure and find the doctors were accepted by the individualized insurance plans - there was a drop down menu to chose the doctors you wanted to be included in your plan.The only two doctors I had highlighted were Doctor [redacted] and Doctor [redacted] Both showed they were accepted by Ambetter Buckeye Health.Then to further my guarantee and knowing that my insurance would be accepted - I called and spoke with Ambetter Buckeye Health representativeNow Ambetter Buckeye is saying that they do not provide the coverage after the last four months I have paid my premiums.I do not know why they allowed [redacted] when I first registered and signed up for AMbetter Buckeye through the Affordable Health Care Marketplace and as soon as they had to pay for a doctor's visit they are saying I am not coveredThis seems like a violation of so many things!Regards, [redacted] Regards, Candace Hatmaker

They could has easily sent the letter through hereIf it does not reach me in the time frame given, then it would silly of me to accept a letter I haven't read yetI will be scanning and sending copies of the letters they have sent me hopefully tomorrowI was out of the country for days or I would have already sent them

Ambetter from Buckeye Health Plan has completed our review of the complaint received by your officewith ID #***Ambetter from Buckeye Health Plan has been in contact with the complainant in the past, and hasattempted unsuccessfully, via phone and email, to contact the
complainant following receipt of thecomplaintWe will continue to try to outreach to him until a resolution is reachedWe have provided, viaemail, our Customer Service Supervisor's direct phone number to assist him with his concerns.Sincerely,Ambetter from Buckeye Health Plan

Hello, we are not able to assist with this compliant as this individual is not a member of the Buckeye Health Plan (Ambetter)As a result, please reach out to Superior Health Plan located in TexasTheir address is: *** ** *** *** *** *** ** *** Thank
you, Toni C***

The response is addressed to *** *** That is not me!!
I feel that Ambetter is not clearly hearing my complaint(s) I don't know how much louder that I can emphasize "BAIT AND SWITCH." This is both disrespectful and ignorant My complaint stands, and my requests still remain unmet I encourage Ambetter to review this complaint again, and come up with an intelligent response this time
Regards,
*** ***

After review, we determined that the claim in question was processed correctly. Practitioner [redacted] is participating in our other lines of business, but not with...

Ambetter. Since the provider is not participating with Ambetter and there was no authorization to have the services rendered, they have the right to balance bill you for anything that was not paid.  We also checked your records and did not show where you were advised by Ambetter that this was a participating provider.  We researched the web portal and our database and was also able to determine that the provider was not able to be located on the portal. It is your responsibility to ensure you are using participating providers prior to services being rendered. We apologize for any inconvenience this issue may have caused you.

Dear Revdex.com of Ohio,After review of the complaint filed by an Ambetter member, [redacted]. We have researched the complaint and a letter has been sent out to the member informing her of conclusion of this review.Thank you for bringing this individual's concerns to our attention and...

allowing us the opportunity to respond. Thank youNatalie L. T[redacted]Grievance and Appeals Coordinator I

Dear Revdex.com of Ohio,After review of the complaint #[redacted] filed by an Ambetter member, [redacted]. We have researched the complaint and a letter has been sent out to the member informing her of conclusion of this review.Thank you for bringing this individual’s concerns to our...

attention and allowing us the opportunity to respond.Thank you.Shamain M[redacted]

Hello, thank you for your email. We are currently reviewing this inquiry and will respond soon with our findings.

I received both these two letters from two different departments at Ambetter.  One says that I am still active and owe them money. It outlines the two very different policy rates.  A base rate of approximately $212 for coverage in 2017 and approximately $325 in 2018.  I was billed twice for the 2018 policy which I cancelled and refunded only once.  The other letter states that I cancelled before the 2018 effective date of coverage appropriately.  The Marketplace also stated multiple, different times that I never filed an application for coverage in 2018.  I e-mailed both of these letters directly to Natalie who stated, "I was only going off the information I could see."  However, she responded quickly that she would look into it again on Monday.  I would like this complaint to remain open accordingly.

Dear Revdex.com of Ohio, Ambetter from Buckeye Health Plan has completed the Revdex.com of Ohio (Revdex.com) review for one of our members. Please see the following information below regarding the outcome of our review, referenced by Revdex.com case [redacted]. After review of the...

complaint filed by our member regarding the denial of claims for February 2017 under the Ambetter plan, it has been determined that Ambetter has denied the claims due to Dr. Richard [redacted] not being a participating provider within the Ambetter network. According to the Ambetter plan, it is the member’s responsibility to ensure that they are utilizing participating providers prior to services being rendered.  We have reviewed the members records and was not able locate any phone calls pertaining to verification of Dr. [redacted] participating within the Ambetter network. Therefore, the claims for Dr. [redacted] due to non-network participation. If the member does not agree with our determination, our member has the right to file a claim dispute within 180 days from the date of the denial. Please submit all claim disputes to the following address below. Ambetter form Buckeye [redacted] Thank you for the opportunity to review our member’s complaint, and to offer a response. We hope that this outcome is favorable to our member.  Thank you, [redacted] Buckeye Health Plan

I am rejecting this response because when I initially researched the marketplace for affordable health care insurance plans. The process to ensure and find the doctors were accepted by the individualized insurance plans - there was a drop down menu to chose the doctors you wanted to be included in your plan.The only two doctors I had highlighted were Doctor [redacted] and Doctor [redacted]. Both showed they were accepted by  Ambetter Buckeye Health.Then to further my guarantee and knowing that my insurance would be accepted - I called and spoke with Ambetter Buckeye Health representative. Now Ambetter Buckeye is saying that they do not provide the coverage after the last four months I have paid my premiums.I do not know why they allowed [redacted] when I first registered and signed up for AMbetter Buckeye through the Affordable Health Care Marketplace and as soon as they had to pay for a doctor's visit they are saying I am not covered. This seems like a violation of so many things!Regards,[redacted]
Regards,
Candace Hatmaker

Revdex.com:
I reviewed the response made by the business in reference to complaint ID [redacted],  I understand that they are not the branch of the company that handles my policy. However, I DO have "Ambetter" insurance and can literally login on their [redacted] website, so they are not some other company, I did not see one of their entities in Texas when filing this complaint, but they are the same people. Please forward my complaint to the Texas Revdex.com if you are able.  
[redacted]

Ambetter from Buckeye Health Plan has completed our review of the complaint received by your officewith ID #[redacted].Ambetter from Buckeye Health Plan has been in contact with the complainant in the past, and hasattempted unsuccessfully, via phone and email, to contact the complainant following...

receipt of thecomplaint. We will continue to try to outreach to him until a resolution is reached. We have provided, viaemail, our Customer Service Supervisor's direct phone number to assist him with his concerns.Sincerely,Ambetter from Buckeye Health Plan

The response is addressed to [redacted].  That is not me!! I feel that Ambetter is not clearly hearing my complaint(s).  I don't know how much louder that I can emphasize "BAIT AND SWITCH."  This is both disrespectful and ignorant.  My complaint stands, and my requests still remain unmet.  I encourage Ambetter to review this complaint again, and come up with an intelligent response this time.
Regards,
[redacted]